A1 Level 1 : Learning activity 3 : Stage 3

MOVING TO A NEW PLACE

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application
Gorm
Please write the first or main applicants surname here

Duran

Important: Please make sure you read all the information presented in this document carefully before
you complete this form.

A. Your details
First name(s)

Yahir

Give any other name(s)

you were previously known by

02/12/1995

Date of birth
For example 06/12/1968
Current address

Street 6 # 2 - 04 North

Postcode
Contact/correspondence

Street 7 # 4a -02 North

or safe address (if different

from above)
Contact telephone

3219352362

numbers(s)
Email address

duranyahir@gmail.com

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

Do you experience difficulties

Yes

No

with reading or writing?

Whats your gender?
What is your religion?

Male

Female

Prefer not to say

Buddhist
Christian

Hindu
Jewish

Muslim Sikh

None

Other

(please specify)

B. Employment information
If you are working, please tell us:
What do you do?

Yes

No

messenger and referee

C. Your family or household

We need to know if other people will be moving with you. This will help us to know what type of home
you will need. Please give their details below.
1st

2nd

3rd

Last name

Duran

Cristancho

Pacheco

First name

Yeinner

Bertina

Leiddy

Date of birth

07/10/1993

22/04/1973

22/11/1997

Gender

male

female

female

Relationship

brother

mother

girlfriend

to you (wife,
son, etc.)

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

D. Your present accommodation/circumstances

Tick the box against the property type in which you live or best describes your circumstances.

House

Trailer

Hostal

Flat/apartment

condominium

Hotel

Bungalow

Cottage

Terraced house

Detached house

Semi-detached house

No fixed address

E. Your house preferences

State your house preferences describing all the characteristics you want your new home to have.

House type (apartment, cottage, etc.)

house

Number of rooms

three

Number of bathrooms

two

Which floor (if located in a building)

one

Public utilities (gas, water, etc.)

Electricity, Gas, Water

Location

Ciudad Bucaramanga

Price

two hundred thousand pesos per month

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

F. Special requirements
Write a more detailed description of the kind of house you want to have.

Im looking an house in a tranquil zone and close to comercial areas

G. Applicants signature
Name

Yahir Duran

Date

14/07/2015

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.